<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    <!--
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="">
        </div>
    </div>
    -->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Doctor_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-doctor_name" class="form-control" name="row[doctor_name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Hospital')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-hospital" data-rule="required" class="form-control" name="row[hospital]" type="text">
        </div>
    </div>
    <!--
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Users_total')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-users_total" data-rule="required" class="form-control" name="row[users_total]" type="number" value="0">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_total')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_total" data-rule="required" class="form-control" name="row[order_total]" type="number" value="0">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Total_consume')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-total_consume" data-rule="required" class="form-control" step="0.01" name="row[total_consume]" type="number" value="0.00">
        </div>
    </div>
    -->
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
